Melanie Nacey

Westmoreland Hospital
4-20-22
6:30-1:00
Week 14
Dr. Williams/Mrs. Carr
Reflective Journal Final 2022
Throughout my clinical experience I have seen many new patients with different clinical
pictures. Some of my patients recently have had a mass of their colon. I have had several
patients recently admitted for hypoglycemia and cellulitis in their diabetic ulcers. I have also had
patients with infections such as MRSA and VRE. Many of my patients are postsurgical. For the
care of the diabetic patient I monitor their blood glucose levels and assess their skin integrity.
For post surgical patients I try to help the patient with ambulation and sitting in the chair to
prevent deep vein thrombosis and pulmonary embolism.
To start my clinical day I listen to report from the night shift nurses and determine which
patient of the two would be a priority to see first. To determine this I look at my patients’ charts
to see the different medications they are on, any orders they may have, and their admitting
diagnosis and past medical history. I then go in and introduce myself to the patient and take
their vitals and complete a head-to-toe assessment. I do this by auscultating lung sounds, heart
sounds, and bowel sounds. I perform a neuro exam by assessing the patient’s pupils and level
of consciousness. I assess the patient’s skin integrity during their bath and their perfusion by
feeling the temperature and color of their skin along with assessing their pulses bilaterally. When
completing my assessments I ask my patient about their pain and determine if they need any
pain medications before my medication pass. After this I pass my medications. Once
medications are administered I chart my assessments and reassess my patient. Reassessment
is especially important when I am giving pain medications or medications that can affect the
patient’s blood pressure and heart rate. During the medication administration I have found the
skill of patient education very important. Many patients do not know what medications they are
given or why they are given, so the nurse should provide this information to the patient before
they take the medication. I am constantly updating my nurse on the patient’s status and
consulting with her on any problems I may be having. Throughout the day I am reassessing the
patient frequently and helping them with any of their needs (hygiene, toileting). After one
semester at Westmoreland Hospital I think I have become much more familiar with their charting
in Cerner. After a whole year of clinical experience I find that my routine has become a lot
smoother. I do my patient care much quicker, and I know what situations need my priority. One
improvement I could make would be to become quicker with my medication passes. Once I am
a working nurse I will have more than one patient that I am passing medications on, so I will
need to improve my speed of passing medications, especially in patients with many medications
and different routes of administration.
Some additional opportunities I have sought out were helping my classmates with their
patients. I have helped many classmates with bathing, ambulating, and toileting their patients
this semester. Additionally, when we began having two patients I was able to experience many
different clinical situations. I have done wound care and dressing changes on two patients. I
have seen a blood transfusion, a nasogastric tube, and a patient controlled analgesia pump.
 After looking back at my reflective journal at midterm I believe I have improved greatly.
Overall I think I improved on my confidence and demeanor when working with patients. At the
start of the semester I still felt panicked and anxious when working with patients, especially
when doing something I have never done before. Now I feel more at ease and confident with the
care I am giving to my patients. When I hung my first IV bag I felt very nervous, but now after
hanging five or six IV bags I feel much more confident with doing so. Practicing these skills has
really helped me grow comfortable with my care. As stated before I feel that my clinical days run
very smoothly now. I would like to continue receiving practice with different medication
administrations. In nursing I feel as though there are so many new skills to learn and sometimes
I worry that I will not know all of these skills once I graduate. But, I have found this semester that
I did practice many different skills such as IV administration, wound care, subcutaneous
injections, and etc. I think through clinicals next year and my externship in the summer I will
continue to learn. After clinical and class this year I have created a strong base in my
knowledge, and this will help me grow as a nurse in the future. I feel as though I can talk about
different diseases and lab values now that I did not know at the beginning of the semester or
even at the beginning of the school year. One area I would still like to grow upon is my
confidence in my practice. While I stated that I have gained confidence I still think it is always a
good goal to have for myself. I also would like to improve my communication skills with other
members of the healthcare team. As a student nurse I often feel that my opinion on the patient
may not be extremely important to other health care workers, but it definitely can be. I think
working on this skill while I am in school will definitely help me communicate better with the
doctors, physician assistant, and other nurses once I graduate. After a whole year of clinical
experience I have learned so many new skills through practicing them at the hospital. Over the
summer and next year I want to continue my practice and learning through many new clinical
experiences.